Humber River Hospital: The First Fully-Digital Hospital in North America By: Natalie Guriel (Copyright 2022) Humber Rive
Posted: Mon Jun 06, 2022 6:53 am
Humber River Hospital: The First Fully-Digital Hospital in North
America
By: Natalie Guriel (Copyright 2022)
Humber River Hospital (HRH) in Toronto, Ontario, re-opened as a
new facility in October 2015. The new hospital was praised for
being the first fully-digital hospital in North America, equipped
with a variety of technologies to improve healthcare delivery and
patient experience.
HRH’s $1.8 billion investmenti was founded on automation,
electronic information, analytics and mobile communication to
reduce operational costs and improve patient care. ii By
2016, HRH had achieved automating about 75% of its
back-of-the-hospital functions such as pharmacy, laundry and food
delivery.iii
HRH was one of Canada’s largest acute care hospitals, with 656
acute beds, including 48 critical care beds. HRH was staffed
with about 600 physicians and 500 volunteers.iv
By 2022, the technology investment had already saved the
hospital significant operational costs. For example, there were
$3.2 million in annual energy savings.v In comparison, the
hospital used 40% less energy compared to an average
hospital. vi Subsequently, HRH was the most
energy-efficient hospital in North America. Part of this cost
savings was also attributed to its building design.
The design of the building met the guidelines and sustainability
principles of the Leadership in Energy and Environmental Design
(LEED) rating system to help reduce the impact of global climate
change. The hospital also used recycled materials and locally
sourced products. And automated climate and lighting controls
contributed to more sustainable energy usage.vii
In the hospital, robots were purchased to deliver supplies,
allowing staff to spend more time on direct patient care and less
time travelling between departments. Here, labour cost savings were
estimated at $3 million annually.viii
The hospital also launched the World’s First Clinical
Analytic Application system in the
hospital’s Quality Command Centre in 2019 to transform patient
experience.ix With technology developed by GE Healthcare,
artificial intelligence was used to monitor and operate the entire
hospital, creating consistent, timely and reliable
information.x How did this all work?
According to one report, “clinical applications or analytic
‘tiles’ were displayed on large-screen monitors in the
Hospital’s Command Centre. These ‘tiles’ integrate[d] standardized
early warning systems, predictive analytics, real-time information
from multiple digital systems, and professional expertise to
provide an ‘added layer of protection’ for patients with conditions
that [made] them more vulnerable to risks of adverse events,
or adverse outcomes. Through this process, clinical staff
[were] alerted to a changing patient’s condition even sooner,
so that they [could] intervene to keep that patient on
track and advancing towards becoming healthy.” xi
Other technologies included “smart bed technology, robotics
for certain surgical procedures, automated laboratory
processing, automated guided medical supply delivery vehicles and
bedside computer screens that allow[ed] patients to control
their environments.” xii
Managing technology had become an important part of the
hospital’s operations. For example, staff and volunteers
needed special training. Patients also needed to understand some of
the
4|Page
technologies in their own rooms where they could customize and
improve their stay. One of the disadvantages of these new
technologies was that they needed to be monitored and managed. For
example, in June 2021, HRH’s IT systems were struck by a ransomware
attack, where the hospital had to shut down its 5,000
computers to protect hospital records and patient data from harm,
raising privacy concerns. The cyber attack forced the closure of
some clinics and services impacting patient care until the
hospital’s systems had received a security patch.xiii
In 2019, Canadians were not only becoming more concerned about
privacy issues but also living a healthy and active lifestyle.
Living a healthy lifestyle included access to quality and universal
healthcare with adequate staffing levels in hospitals and other
healthcare-related settings.
In an Ipsos survey, 90% of Canadians agreed that improvements
were needed to the province’s healthcare system such as
additional beds, increased staff, and further capital investments
in hospitals and clinics. However, 52% of Canadians
agreed that their province’s rate of healthcare spending
was unsustainable.xiv
On April 18, 2019, the Ontario provincial government passed
Bill 74, The People’s Health Care Act which aimed to create a
more integrated public healthcare system. The Act introduced some
structural changes to connect local healthcare services. The new
legislation also enacted the Connecting Care Act 2019, which
created “Ontario Health”, a super agency (called “the Agency”) that
enabled the creation of integrated care delivery systems
(ICDS). The Act combined 14 existing Local Health Integration
Networks (LHINs) and six provincial health agencies, allowing for
accountability and oversight over Ontario’s healthcare
system.xv
“Under the Act, ICDS models known as “Ontario Health
Teams” [were] being introduced as new ways of organizing and
delivering health care services in local communities. Made up of
providers and organizations including hospitals, doctors and home
and community care providers, Ontario Health Teams [would] be
clinically and fiscally accountable for delivering a full and
coordinated continuum of care to a defined geographic population.
Key components of the Ontario Health Team model include[d] virtual
care and other digital health processes that [would] allow for
greater connectivity between patients, families and the services
required.” xvi
By 2020, another change had occurred, and Humber River Hospital
had new challenges to manage. The covid pandemic had put a strain
on the hospital. With unprecedented hospitalizations, there were
chronic staff shortages of doctors and nurses calling in sick,
which meant the workload became heavier for those health
professionals remaining, leading to burnout and poor employee
morale.xvii
“According to the Canadian Institute for Health Information’s
(CIHI) analysis of COVID-19’s effect on hospital care
services, from March to December 2020, overall surgery numbers fell
22% compared with the same period in 2019, representing about
413,000 fewer surgeries. Alongside spending reductions, there were
spending increases, as additional resources were needed to treat
COVID-19 patients. Per CIHI’s 2021 report on hospital spending, the
estimated average cost of a COVID-19 hospital stay was 3 times
the average cost of a stay for a heart attack.” xviii
The covid pandemic also impacted other areas in society. The
decrease in economic activity in 2020 and fiscal measures to
respond to the pandemic, caused government deficits to soar to
reach record highs. Many analysts agreed that in order for
governments to better manage
5|Page
expenses, healthcare spending may be impacted in the
future. xix Furthermore, new policies may also be needed
to address labour shortages in the healthcare industry.
In 2022, one first step was made. The Province of Ontario
introduced a $5,000 retention bonus for front-line nurses in
publicly-funded facilities to encourage worker retention and to
address the nursing shortage in Ontario.xx The province also
discussed capping public-sector wage increases to one percent per
year to manage rising costs.
By April 2022, the Bank of Canada, the federal crown
corporation, raised interest rates to one percent to help manage
high inflation.xxi While Canada’s health expenditure in 2021
was approximately 12% of Canada’s gross domestic product, an
important contributor to the Canadian economy, the health
expenditure was also a costly one.
Question 1 (20 marks)
Explain how the six (6) external environmental factors have
impacted or are impacting Humber River Hospital. Explain your
answer using examples from this case.
Question 2 (10 marks)
Explain which management philosophy (the classical school or the
behavioural school) may be better suited for Humber River Hospital
and why? Explain your answer using examples from this case.
America
By: Natalie Guriel (Copyright 2022)
Humber River Hospital (HRH) in Toronto, Ontario, re-opened as a
new facility in October 2015. The new hospital was praised for
being the first fully-digital hospital in North America, equipped
with a variety of technologies to improve healthcare delivery and
patient experience.
HRH’s $1.8 billion investmenti was founded on automation,
electronic information, analytics and mobile communication to
reduce operational costs and improve patient care. ii By
2016, HRH had achieved automating about 75% of its
back-of-the-hospital functions such as pharmacy, laundry and food
delivery.iii
HRH was one of Canada’s largest acute care hospitals, with 656
acute beds, including 48 critical care beds. HRH was staffed
with about 600 physicians and 500 volunteers.iv
By 2022, the technology investment had already saved the
hospital significant operational costs. For example, there were
$3.2 million in annual energy savings.v In comparison, the
hospital used 40% less energy compared to an average
hospital. vi Subsequently, HRH was the most
energy-efficient hospital in North America. Part of this cost
savings was also attributed to its building design.
The design of the building met the guidelines and sustainability
principles of the Leadership in Energy and Environmental Design
(LEED) rating system to help reduce the impact of global climate
change. The hospital also used recycled materials and locally
sourced products. And automated climate and lighting controls
contributed to more sustainable energy usage.vii
In the hospital, robots were purchased to deliver supplies,
allowing staff to spend more time on direct patient care and less
time travelling between departments. Here, labour cost savings were
estimated at $3 million annually.viii
The hospital also launched the World’s First Clinical
Analytic Application system in the
hospital’s Quality Command Centre in 2019 to transform patient
experience.ix With technology developed by GE Healthcare,
artificial intelligence was used to monitor and operate the entire
hospital, creating consistent, timely and reliable
information.x How did this all work?
According to one report, “clinical applications or analytic
‘tiles’ were displayed on large-screen monitors in the
Hospital’s Command Centre. These ‘tiles’ integrate[d] standardized
early warning systems, predictive analytics, real-time information
from multiple digital systems, and professional expertise to
provide an ‘added layer of protection’ for patients with conditions
that [made] them more vulnerable to risks of adverse events,
or adverse outcomes. Through this process, clinical staff
[were] alerted to a changing patient’s condition even sooner,
so that they [could] intervene to keep that patient on
track and advancing towards becoming healthy.” xi
Other technologies included “smart bed technology, robotics
for certain surgical procedures, automated laboratory
processing, automated guided medical supply delivery vehicles and
bedside computer screens that allow[ed] patients to control
their environments.” xii
Managing technology had become an important part of the
hospital’s operations. For example, staff and volunteers
needed special training. Patients also needed to understand some of
the
4|Page
technologies in their own rooms where they could customize and
improve their stay. One of the disadvantages of these new
technologies was that they needed to be monitored and managed. For
example, in June 2021, HRH’s IT systems were struck by a ransomware
attack, where the hospital had to shut down its 5,000
computers to protect hospital records and patient data from harm,
raising privacy concerns. The cyber attack forced the closure of
some clinics and services impacting patient care until the
hospital’s systems had received a security patch.xiii
In 2019, Canadians were not only becoming more concerned about
privacy issues but also living a healthy and active lifestyle.
Living a healthy lifestyle included access to quality and universal
healthcare with adequate staffing levels in hospitals and other
healthcare-related settings.
In an Ipsos survey, 90% of Canadians agreed that improvements
were needed to the province’s healthcare system such as
additional beds, increased staff, and further capital investments
in hospitals and clinics. However, 52% of Canadians
agreed that their province’s rate of healthcare spending
was unsustainable.xiv
On April 18, 2019, the Ontario provincial government passed
Bill 74, The People’s Health Care Act which aimed to create a
more integrated public healthcare system. The Act introduced some
structural changes to connect local healthcare services. The new
legislation also enacted the Connecting Care Act 2019, which
created “Ontario Health”, a super agency (called “the Agency”) that
enabled the creation of integrated care delivery systems
(ICDS). The Act combined 14 existing Local Health Integration
Networks (LHINs) and six provincial health agencies, allowing for
accountability and oversight over Ontario’s healthcare
system.xv
“Under the Act, ICDS models known as “Ontario Health
Teams” [were] being introduced as new ways of organizing and
delivering health care services in local communities. Made up of
providers and organizations including hospitals, doctors and home
and community care providers, Ontario Health Teams [would] be
clinically and fiscally accountable for delivering a full and
coordinated continuum of care to a defined geographic population.
Key components of the Ontario Health Team model include[d] virtual
care and other digital health processes that [would] allow for
greater connectivity between patients, families and the services
required.” xvi
By 2020, another change had occurred, and Humber River Hospital
had new challenges to manage. The covid pandemic had put a strain
on the hospital. With unprecedented hospitalizations, there were
chronic staff shortages of doctors and nurses calling in sick,
which meant the workload became heavier for those health
professionals remaining, leading to burnout and poor employee
morale.xvii
“According to the Canadian Institute for Health Information’s
(CIHI) analysis of COVID-19’s effect on hospital care
services, from March to December 2020, overall surgery numbers fell
22% compared with the same period in 2019, representing about
413,000 fewer surgeries. Alongside spending reductions, there were
spending increases, as additional resources were needed to treat
COVID-19 patients. Per CIHI’s 2021 report on hospital spending, the
estimated average cost of a COVID-19 hospital stay was 3 times
the average cost of a stay for a heart attack.” xviii
The covid pandemic also impacted other areas in society. The
decrease in economic activity in 2020 and fiscal measures to
respond to the pandemic, caused government deficits to soar to
reach record highs. Many analysts agreed that in order for
governments to better manage
5|Page
expenses, healthcare spending may be impacted in the
future. xix Furthermore, new policies may also be needed
to address labour shortages in the healthcare industry.
In 2022, one first step was made. The Province of Ontario
introduced a $5,000 retention bonus for front-line nurses in
publicly-funded facilities to encourage worker retention and to
address the nursing shortage in Ontario.xx The province also
discussed capping public-sector wage increases to one percent per
year to manage rising costs.
By April 2022, the Bank of Canada, the federal crown
corporation, raised interest rates to one percent to help manage
high inflation.xxi While Canada’s health expenditure in 2021
was approximately 12% of Canada’s gross domestic product, an
important contributor to the Canadian economy, the health
expenditure was also a costly one.
Question 1 (20 marks)
Explain how the six (6) external environmental factors have
impacted or are impacting Humber River Hospital. Explain your
answer using examples from this case.
Question 2 (10 marks)
Explain which management philosophy (the classical school or the
behavioural school) may be better suited for Humber River Hospital
and why? Explain your answer using examples from this case.